Asystematic review of the number needed to screen for active TB among people living with HIV

L. H. Chaisson, F. Naufal, P. Delgado-Barroso, H. S. Alvarez-Manzo, K. O. Robsky, C. R. Miller, J. E. Golub, A. E. Shapiro

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: Systematic screening for active TB is recommended for all people living with HIV (PLWH); however, case detection remains poor globally. We investigated the yield of active case finding (ACF) by calculating the number needed to screen (NNS) to detect a case of active TB among PLWH. METHODS : We identified studies reporting ACF for TB among PLWH published from November 2010 to February 2020. We calculated crude NNS for Xpertor culture-confirmed TB and weighted mean NNS stratified by screening approach, population/risk group, and country TB burden. RESULT S : Of the 27,221 abstracts screened, we identified 58 studies eligible for inclusion, including 5 in low/ moderate TB incidence settings and 53 in medium/high incidence settings. Populations screened for TB included inpatients, outpatients not receiving antiretroviral therapy (ART), outpatients receiving ART, those with CD4 , 200 cells/lL, children aged ≤15 years, pregnant PLWH, and PLWH in prisons. Screening tools included symptom-based screening, chest X-ray, C-reactive protein levels, and Xpert. The weighted mean NNS varied across groups but was consistently low, ranging from 4 among inpatients in moderate/high TB burden settings to 137 among pregnant PLWH in moderate/high TB burden settings. CONC LUS IONS : ACF is a high yield intervention among PLWH. Approaches to screening should be tailored to local epidemiological and health-system contexts, and sensitive screening tools such as Xpert should be implemented where feasible.

Original languageEnglish (US)
Pages (from-to)427-435
Number of pages9
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number6
StatePublished - Jun 1 2021


  • Active case finding
  • Human immunodeficiency virus screening
  • Number needed to screen
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


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